Background: The paper aims to present the clinical profile and treatment outcomes of both asymptomatic and symptomatic hyperparathyroid patients in our institution. Methodology: This is a retrospective, descriptive study, which involved reviewing histopathology records from 2004 to 2008. Collected data were tabulated. Statistical means and percentages were used to present the results. A paired t test was used to compare continous variables. Results: A total of 12 patients were diagnosed with parathyroid adenoma on final histopathological diagnosis. Ten out of 12 patients underwent unilateral cervical parathyroidectomy, while two patients had incidental findings of parathyroid adenoma after total thyroidectomy. The difference between pre-operative ionized calcium levels of asymptomatic hyperparathyroid patients compared with symptomatic patients were not statistically significant, 1.88 mmol/L ± 0.43 mmol/L vs. 1.80 mmol/L ± 0.29 mmol/L, respectively. All asymptomatic patients satisfied one or more of the updated National Institute of Health guidelines for parathyroidectomy of asymptomatic hyperparathyroidism. Levels of intact PTH postoperatively showed decrease by more than 50% from the pre-operative values from 693.337 pg/mL (± 744.532 pg/mL) to 124.016 pg/mL (± 73.921 pg/ mL) after parathyroidectomy, showing 100% cure rate. Almost 50% of the patients suffered from hypocalcemic symptoms (mean calcium level 1.08 mmol/L) by the second to third post-operative day. Normocalcemia was achieved within one year post-parathyroidectomy. Conclusion: Our study showed that it is prudent to request for repeat serum ionized calcium during the first four days post-operatively, where most of the serum ionized calcium levels of our patients were noted to decrease. Furthermore, we should start our patients with calcium supplementation post-parathyroidectomy, even if initial serum ionized calcium are normal.

Granulomatous hypophysitis is an extremely rare condition, with no established definitive treatment. An elderly Asian woman was diagnosed to have recurrent granulomatous hypophysitis 5 years after transsphenoidal surgery. No other intervention was done post-operatively. Since another surgery was not advisable due to the high probability of recurrence, she was started on a trial of oral glucocorticoids. After 3 months of steroid therapy, complete resolution of symptoms and sellar mass were achieved.
Autoimmune Hypophysitis ; Glucocorticoids

The cell origin, histopathologic features, and prognosis of medullary and papillary thyroid carcinoma are different and to have them occur simultaneously in a single patient is a rare occurrence. This is a case of a 38-year-old female who presented with an enlarging anterior neck mass whose fine needle aspiration biopsy could not rule out a papillary lesion. Thus, she was advised to undergo total thyroidectomy, and her final histopath showed a simultaneous medullary and papillary thyroid carcinoma. Her initial serum calcitonin was elevated at 252 pg/ ml, and it remained persistently elevated over the course of 7 months. A repeat ultrasound revealed solid nodules with coarse calcifications and enlarged lymph nodes at both submandibular regions. This warranted a repeat surgery with neck dissection with the finding of eight lymph nodes positive for metastatic carcinoma. On follow up after her second surgery, the calcitonin decreased to 42.70 pg/ml. Knowledge of this simultaneous occurrence of medullary thyroid carcinoma and papillary cancer is important for its prognostic implications and therapeutic plan
Thyroid Neoplasms ; Thyroid Cancer, Papillary

BACKGROUND: Squamous cell carcinoma (SCC) of the thyroid is a rare condition comprising less than 1% of all thyroid malignancies. Thyroid SCC is a variant of undifferentiated thyroid carcinoma and is also associated with the tall-cell variant of papillary thyroid carcinoma (PTC) and spindle cell carcinoma. Given its aggressive clinical course, early recognition of the disease is essential to management. CASE: We report a rare case of a 67-year-old, Filipino male initially presenting with an anterior neck mass over a period of 11 months. This was accompanied by compressive symptoms, anorexia, and easy fatigability. He underwent total thyroidectomy with histopathology consistent with diffuse sclerosing variant of PTC with squamous differentiation. The patient had rapid tumor growth, tumor recurrence, nodal metastasis, and invasion of local structures within a year after his initial presentation. He underwent completion thyroidectomy and selective neck dissection and concurrent chemo-radiotherapy with a course of radiation (60 Gy in 33 fractions) and chemotherapy with Carboplatin and Paclitaxel. After 13 months of initial presentation, the patient eventually succumbed to cardiac arrest. CONCLUSION This transformation of the thyroid is an aggressive malignancy with increased mortality; hence it should be considered in cases presenting with progressive clinical behavior. Due to his aggressive disease, the patient’s nutritional status, airway protection, and immunity were compromised. A combined modality with surgery, radiotherapy, and chemotherapy to prevent disease progression may be needed due to its aggressive clinical course.

Osteonecrosis of the jaw (ONJ) and atypical femoral fracture (AFF) are rare potential adverse effects of bisphosphonates and RANKL antibody therapy. The pathogenic mechanisms of both conditions are known to be independent of each other. Here, we report both conditions sequentially occurring in the same patient.An 81-year-old, obese, diabetic, female was admitted due to hypertensive urgency and persistent jaw pain after tooth extraction. The patient has postmenopausal osteoporosis for fourteen years and was on intermittent, unsupervised treatment with alendronate, denosumab and ibandronate. Upon presentation, the patient was noted with tenderness intraorally of tooth number 35 periapical region. This was associated with elevated erythrocyte sedimentation rate and C-reactive protein. Imaging study showed presence of bony sclerosis which represent a sequestrum in the molar area of the left hemi-mandible. Antibiotic infusion and excision and debridement of left posterior mandible were done. Histopathologic finding was consistent with a diagnosis of osteonecrosis of the jaw. The same patient, upon review, had suffered sequential fracture of both femurs during the eighth and eleventh year of treatment with antiresorptive agents. The fractures were transverse, non-comminuted, at the proximal femoral shaft. Each occurred after a minor trauma and was managed with open reduction and internal fixation. Both fractures were consistent with atypical femoral fractures.ONJ and AFF can occur both in the same patient during prolonged treatment with bisphosphonates and denosumab and may suggest a common pathogenic mechanism.
Osteoporosis